Inflammatory Bowel Disease 2 Flashcards
What drug is not approved for IBD but used for steroid sparing as a maintenance agent
Azathioprine
What is azathiprine a prodrug for in IBD, what are the hepatotoxic metabolites
Thioguanine nucleotide (6-TGN), methylmercaptapurine and methylmercaptopurine nucleotides
What are the serious side effects of Azathioprine
Hepatotoxicity (6-MMP), Bone Marrow Suppresion (6-TGN), lymphoma
How does the risk of lymphoma increase with azathioprine
TNF-alpha blockers used simultaneously
What should be monitored at the start of azaththioprine therapy for IBD, what are the levels that should lead to complete avoid or reduced dose
TPMT enyzme activity, less than 4 nmol/hour/ml RBCs (azathioprine should be avoided), between 4 and 12 nmol/hour/ml RBCs (dose should be cut in half)
What should be monitored during therapy use of azathioprine
CBC, LFTs weekly for 1 month, monthly for 3 months, then every 3 months
What is the MOA methotrexate, how can thismedication be taken
inhibit DNA synthesis, targets actively proliferative tissue, anti-inflammatory activity/ IM, SC or by mouth weekly
What must be given in conjunction with methotrexate
one gram of Folic acid
What should be monitored when taking methotrexate
CBC,LFTs weekly for 1 month, monthly for three months, then every 3 months
When treating IBD when is azathioprine avoided, methotrexate
in young males, women of childbearing potential
When should cyclosporine and tacrolimus be used in IBD
reserved for severe, treatment-refractory colitis (primarily UC)
When should antibiotics be used in IBD
as adjunctive therapy when there is a bacterial infection
What are the two antibiotics that can be taken for IBD, What are severe adverse effects that come from each drug and what triggers them
Metronidazol: Disulfiram reaction when used with alcohol, ciprofloxacin: tendon rupture in patients on high dose steroids
What are the Anti-TNF-alpha biologics used in IBD
Infliximab/Remicade, Adalimumab/Humira, Certolizumab/Cimzia, Golimumab/Simponi
Which Anti-TNF-alpha biologic can be used for Ulcerative Colitis and Crohn’s Disease
Infliximab and Adalimumab
Which Anti-TNF- alpha biologic can be used for only Ulcerative Colitis, only Crohn’s Disease
Golimumab, Certolizumab
Which Anti-TNF-alpha biologic is strictly IV
Remicade
What is the black box warning for Anti-TNF-alpha biologics
increased risk of lymphoma when used in conmitant therapy with immunomodulator, nonhodkin’s lymphoma, melanoma
T/F: Anti-TNF-alpha can worsen congestive heart failure
True
What should be monitored before using antt-TNF-alpha biologics
Quantiferons, Hep B, CBC, LFT, TB
What should be monitored when using anti-TNF-alpha biologics
drug levels and anti-drug antibodies
What are primary non responders anti-TNF-alpha therapy
Not responsive to therapy, 60% more responsive after switching to a different anti-TNF-alpha biologic
What are secondary non responders in anti-TNF-alpha biologics
Were responsive at first but are no longer responsive, most likely to be creating antibodies
When is anti-TNF-alpha biologics in combination with immunomodulators the first line of therap
in moderate to severe Crohn’s Disease
